New and improved testing methods are enabling doctors performing IVF to transfer healthy embryos at a more developed stage, both of which increase the chance of a successful pregnancy.

And has recently made the leap from an experimental procedure to a successful – if less common – way to preserve and extend fertility.

The concerning news? Insurance coverage for these expensive procedures has not kept pace with the technology. According to a 2006 study by Resolve: The National Infertility Association, only 20 percent of U.S. employer-sponsored health insurance plans offer coverage for fertility treatments. The businesses surveyed that didn't offer coverage cited cost as the number one reason.

And some advocates for affordable reproductive technology say the Affordable Care Act won't help matters. The healthcare legislation doesn't mandate coverage for infertility. Instead, it's up to individual states to require that participating insurance plans cover it – or not.

Advances in embryo screening

Though IVF is expensive, emotionally and physically challenging, and time consuming, it offers a big advantage for couples trying to conceive: Doctors can do a checkup on an embryo's health before it's transferred into a woman's uterus.

That means prospective parents who have completed the many steps of fertility treatment can (hopefully) choose from a number of embryos to pick those with the highest likelihood of implanting. If the embryo transfer results in a successful pregnancy, their baby is very likely to be born healthy.

The tests take two forms. Pre-implantation screening uses a sample of cells from an embryo created by IVF to identify chromosomal abnormalities such as trisomies like Down syndrome. Pre-implantation diagnosis enables couples in which both parents carry a recessive gene for a particular condition, such as cystic fibrosis or Tay Sachs, to find out if embryos created by IVF have inherited the disorder.

Both of these procedures have been used for some time, but now an enhanced technology called microarray CGH enables experts to perform both of those tests at the same time, exposing the embryo to less risk while yielding more accurate results.

And in addition, technical improvements in developing embryos outside the womb allow researchers to conduct these tests on cells removed from embryos grown to the stage of blastocysts – two days later than in the past.

Because there are more cells at this stage, experts can biopsy more of them – leading to better results, says Pasquale Patrizio, a professor of obstetrics, gynecology, and reproductive sciences and director of the Yale Fertility Center at Yale University School of Medicine. And at this point, there's less risk of harm to the precious embryo.

"This doesn't impact the growth of the embryo and is much more accurate," says Patrizio.

Both of these advances mean that pregnancy success rates after implantation are on the rise, he says, because once embryos reach the blastocyst stage and then are screened, there's a better chance that they will be able to implant and develop into a healthy baby.

Better egg-freezing technology

Though it sounds like science fiction, women can freeze their eggs to create children in the future. The technology has been around for a while, but experts didn't know until recently how successful the procedure would be.

Turns out that it's very successful. Amazingly, when used for IVF, the frozen eggs are just as likely to lead to pregnancy as eggs retrieved right beforehand.

"The technology is pretty much at the point of creating almost the same success rate as when you use fresh eggs," says Patrizio.

This is wonderful news for women undergoing medical treatments (such as chemotherapy for cancer) that might harm their eggs. By removing and freezing their eggs, they can preserve their fertility.

It's also important to women delaying motherhood for any number of reasons – personal, professional, you name it. This group, which represents most of the women currently taking advantage of this technology, now has the option of preserving younger (more healthy) eggs to use later.

The technology of egg freezing has gotten so good, Patrizio says, that some fertility centers in the United States are creating egg banks similar to sperm banks. Traditionally, couples who use a donor egg must find a live donor, wait for her to undergo tests to make sure she and her eggs are healthy, and wait to have her eggs retrieved, all of which takes time. Egg banks have frozen eggs ready to be thawed and fertilized, so the whole process can be much faster and less costly.

So far, eggs have been successfully used after being frozen for 10 years. Patrizio expects that advances in egg-freezing technology will continue to extend this timeline. Someday, 25-year-olds might routinely freeze their eggs to use at age 45 or later.

Uncertainty over coverage

The Affordable Care Act (ACA) requires that health insurance plans cover a set of essential health benefits. Though advocates for more affordable assisted reproductive technology sought to have fertility treatment included in those benefits, they didn't succeed. That means that it's up to individual states to determine whether they will require fertility treatment to be covered by the plans in their health insurance exchanges.

Currently just 15 states mandate that health insurers offer some kind of coverage for infertility. Some advocates for IVF insurance coverage believe no new states will join that list and worry that some could drop off.

"There will be zero chance of a state passing a new mandate in the next couple of years," says Barbara Collura, president and CEO of Resolve. "The excuse that we're getting is, 'Hey, let's just see how implementation plays out.'"

However, the ACA will eliminate the possibility that health insurance plans can consider infertility a pre-existing condition and deny coverage based on that. The legislation also includes a small increase in the maximum allowed tax deduction for fertility-related services, from 7.5 percent of pretax income to 10 percent.

How to make treatment more affordable

Until the effect of the ACA is more obvious, you can always lobby on your own behalf. "There is still an opportunity for people to talk to HR departments, to talk to their employers," says Collura. Employers can add coverage for assisted reproductive technology to the plans they offer.

Because so many patients pay out of pocket for IVF and other fertility treatments – and the average cost for one round of IVF is a hefty $12,400 – many clinics offer financing options.

"Don't be afraid to ask," says Collura. "You can say, 'This is going to be a real stretch, can I get some information from your office on grants, payment plans, reduced prices? Tell me what resources are out there to make this possible for me.'"

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